Madagascar is experiencing a large outbreak of plague affecting major cities and other non-endemic areas since August 2017. Between 1 August and 15 October 2017, a total of 849 cases (suspected, probable and confirmed) including 67 deaths (case fatality rate 7.9%) have been reported from 37 (32.5%) out of 114 districts in the country. Of these, 568 cases (67%) were clinically classified as pneumonic plague, 155 (18.3%) were bubonic plague, one case was septicaemic plague, and 125 cases were unspecified. At least 39 healthcare workers have contracted plague since the beginning of the outbreak.

Of the 849 reported cases, 78 (9.2%) were confirmed, 304 (35.8%) were classified as probable after testing positive on rapid diagnostic tests (RDT) and 467 (55%) remain suspected. Eleven strains of Yersinia pestis have been isolated and were sensitive to antibiotics recommended by the National Program for the Control of Plague.

Eighteen (81.2%) out of 22 regions in the country, including traditionally non-endemic areas, have been affected. The district of Antananarivo Renivohitra has been the most affected, accounting for 57.1% of the reported cases. As of 16 October 2017, a total of 3745 contacts were identified, 79.2% (2 967) of them were followed up on the day of reporting.

Plague is endemic on the Plateaux of Madagascar, including Ankazobe District where the current outbreak originated. There is a seasonal upsurge, predominantly of the bubonic form, which occurs every year, usually between September and April. The plague season began earlier this year and the current outbreak is predominantly pneumonic and is affecting non-endemic areas including major urban centres such as Antananarivo (the capital city) and Toamasina (the port city).

Red Cross warns stigma could worsen Madagascar plague outbreak

YAOUNDE (Thomson Reuters Foundation) - The death toll from the plague which is spreading in Madagascar has risen close to 100, and the Red Cross has warned that growing stigma attached to the disease could undermine efforts to contain the outbreak.

While cases of bubonic plague occur in Madagascar nearly every year, this year’s epidemic is “much more dangerous”, said Elhadj As Sy, secretary general of the International Federation of Red Cross and Red Crescent Societies (IFRC), from Madagascar.

This year, plague arrived earlier than expected, and has become much more contagious as it is now being transmitted from person to person through the air in its pneumonic form, as well as from animals to humans through infected flea bites in its bubonic form.

The infection is also spreading in urban centers and in areas that until now had not been affected, the World Health Organization (WHO) said this week.

IFRC staff on the ground say panic is exacerbating the stigma around the plague, Sy told the Thomson Reuters Foundation.

There is a risk this could “drive people underground and that may result in us losing some of the contacts we are tracing in order to contain the outbreak”, he warned. “Our volunteers are working in communities convincing people to seek help.”

The Red Cross is using burial practices that avoid contact with corpses and has opened a plague treatment center to help Madagascar tackle its worst outbreak of the plague this century.

The latest figures from Madagascar’s health ministry show there have been 911 recorded cases of the plague across 17 of the island nation’s regions since August, killing 95 people so far.

“The number of cases is growing by the day,” Sy told the Thomson Reuters Foundation, adding that the seriousness of the outbreak requires “great vigilance”.

The IFRC has introduced the same “safe and dignified” burial methods used in West Africa during the 2014-2016 Ebola epidemic, which are also being followed by the WHO and local government authorities to limit the spread of the plague.

Experience has shown such practices cut the chain of transmission, by preventing further infections through direct contact with corpses, while enabling families and relatives to bury their dead in line with local customs.

Hospitals in Madagascar are on high alert and are implementing preventative measures, medical staff said.

“We are limiting the number of visitors, and stipulating that all the health professionals wear a mask when they meet a patient,” said Mamy Randria, head of the clinic for infectious diseases at the public hospital of Befelatanana in Antananarivo.

“People are aware of the problem - they know that if you have a fever and have other symptoms, you need to seek medical attention,” he said by phone from Madagascar’s capital.

The IFRC, WHO and other international agencies are also providing ambulances to ensure patients with suspected cases do not spread the virus by taking crowded buses and taxis.

Another focus is on improving community surveillance, so as to detect infections earlier.

Sy said building partnerships and trust at the community level is critical, as well as reinforcing an existing referral system for suspected cases.

But overcoming the plague will require longer-term assistance, he emphasized – “not just intervening at the peak and then forgetting about it”.

UNITED NATIONS — The number of plague cases in Madagascar has almost doubled over the last five days and medical experts project the situation will worsen, with 1,000 cases expected every month if funds aren’t rapidly provided, the United Nations said Thursday.

UN spokesman Stephane Dujarric told reporters that only 26 percent of the $9.5 million needed to combat the outbreak of the often deadly disease has been received.

Dujarric said UN humanitarian officials in the Indian Ocean island nation reported 1,032 cases as of Wednesday, 67 percent of which were pneumonic plague. He says that “is more serious than the bubonic plague and highly challenging to control.”

So far, he said, 89 deaths have been counted, including 13 on Tuesday.

Dujarric said UN officials have strengthened systems to identify contacts of victims, monitor the number of patients at hospitals, transport medical samples and address “the transmission risks of traditional burial practices.”

Madagascar has about 400 plague cases per year, or more than half the world’s total, according to a 2016 World Health Organization report. Usually, they are cases of bubonic plague in the rural highlands. Bubonic plague is carried by rats and spread to humans through flea bites. It is fatal about half the time if untreated.

For the first time, though, this outbreak is largely concentrated in the country’s two largest cities, Antananarivo and Toamasina.

Most of the cases in the current outbreak are pneumonic plague, a more virulent form that spreads through coughing, sneezing or spitting and is almost always fatal if untreated. In some cases, it can kill within 24 hours. Like the bubonic form, it can be treated with common antibiotics if caught in time.

Global health officials have responded quickly.

The World Health Organization, criticized for its slow response to the 2014 Ebola epidemic in West Africa, has released $1.5 million and sent plague specialists and epidemiologists. The Red Cross is sending its first-ever plague treatment center to Madagascar.

But, Dujarric said, “Medical experts project that the situation will continue to deteriorate, with 1,000 cases per month expected if the response is not rapidly funded.”

Madagascar: Plague Outbreak Situation Report, 22 October 2017

On October 4 the Government launched its response plan, mobilizing community authorities and civil servants, reducing large gatherings, and temporarily closing schools – currently until early November.

UNICEF Madagascar is deploying its full resources in support of the Government’s efforts to bring Madagascar’s current plague outbreak under control, working in close collaboration with the World Health Organization (WHO) and other partners. Over the past two weeks, outbreak control efforts have significantly accelerated to facilitate detection of plague cases, access to treatment and tracing of people who have come in close contact with infected individuals.

Madagascar experiences annual outbreaks as the plague remains endemic in rural parts of the country, however the current outbreak is particularly concerning due to the predominance of pneumonic plague among confirmed cases - the most dangerous and contagious clinical form of plague, and given the high case load found in urban centres (particularly the capital Antananarivo and the main port Tamatave)

As of 19 October, a total of 1,297 plague cases have been notified (among these 131 confirmed, 574 probable and 592 suspected cases), with numbers indicating two concurrent epidemics of pneumonic (human to human transmitted) and bubonic (flea-bite transmitted) plague forms: 846 pneumonic, 270 bubonic, 1 septicemic, 180 nonspecified). Among these, 102 deaths have been recorded and 39 of the country’s 114 districts are affected. The WHO currently rates the outbreak as high risk at national level, medium risk at regional level and low risk at international level.

UNICEF has been leading communication efforts to ensure that the population is sufficiently sensitized to report any plague symptoms early and thereby facilitate access to treatment. UNICEF interventions have further focused on supporting Ministry of Health case management and community response interventions, leading WASH interventions in hospitals and care centres, as well as providing support to the Ministry of Education to establish special prevention measures in schools.

Situation in Numbers

1,297Total cases notified, of which 846 pneumonic plague cases reported in various locations of the country, notably the urban areas of Tamatave, and Antananarivo

102Deaths reported

39Out of 114 districts in Madagascar have been affected with the highest number of cases detected in the capital

Madagascar is one of a few countries globally where the plague remains endemic. Plague outbreaks, which occur annually in Madagascar, are usually confined to remote rural areas and triggered by the wide-spread ‘slash and burn’ practice as rats which carry the fleas carrying the bacteria Yersinia pestis move towards habitation locations thereby facilitating human infection through flea bites – resulting in the bubonic form of the plague.

The current outbreak features two concurrent epidemics: A bubonic plague outbreak and a second epidemic of the highly contagious pneumonic plague, which is spread through human to human transmission - with the majority of the reported cases being pneumonic plague. Of concern is that the majority of this year’s cases are in densely populated urban areas including the capital Antananarivo (3,724,021 population), and the two coastal towns of Tamatave (1,412,021 population) and Mahajunga (889,277 population). The recovery rate from plague infection is excellent if treated rapidly with antibiotics. However, if not diagnosed and treated immediately, death occurs within one-three days.

Given the annual recurrence of plague outbreaks, Madagascar has in place basic plague control measures and good technical expertise especially via the Institut Pasteur Madagascar. However, due to the overall weak state of the health system and the new dimension with the current outbreak being concentrated in urban centres and the much greater magnitude, the country does not have the capacity to respond to the situation without additional international technical and financial support. The WHO has to date classified the current epidemic as high risk for the country, medium risk for the region, and low risk globally.

Aid group says Madagascar plague outbreak yet to reach peak

The Associated Press Published Monday, October 23, 2017 10:52AM EDT

ANTANANARIVO, Madagascar - An international aid group says a deadly outbreak of plague in Madagascar has not yet reached its peak.

Action Against Hunger said Monday that 102 plague deaths have been reported since the outbreak began in August and that most of the nearly 1,300 reported cases of plague are of the pneumonic kind, a more virulent form that spreads through coughing, sneezing or spitting and is almost always fatal if untreated. It says the highest number of cases have been detected in Madagascar's capital, Antananarivo.

Plague outbreak deaths rise

23 October 2017

HEALTH

The Madagascan plague outbreak has killed at least 94 people, with the number infected since August now thought to be around 1,150.

The recent surge in deaths, and the spread of the disease to major cities, has led authorities to warn travellers to avoid the country. The UK’s Foreign and Commonwealth Office (FCO) has updated its travel advice for UK tourists, stating: “There is currently an outbreak of pneumonic and bubonic plague in Madagascar. Outbreaks of plague tend to be seasonal and occur mainly during the rainy season, with around 500 cases reported annually. Whilst outbreaks are not uncommon in rural areas, the latest outbreak has seen an increase in reported cases in urban areas, including Antananarivo.”

The FCO also told travellers to make sure that their travel insurance will allow for repatriation from the country or medical treatment abroad in case of infection. Authorities from Australia, Portugal and the UAE have mirrored the FCO’s warnings.

The World Health Organization (WHO) has clarified that most of the cases reported have been of pneumonic plague, which can be treated with antibiotics in its early stages. It has also stated that it believes the risk of global outbreak is low, and has advised against travel and trade restrictions.

Nine countries including British holiday hotspots have been issued with plague warnings after an especially deadly outbreak in Madagascar. Health officials in the Seychelles, South Africa and La Reunion - among others - have been told to be vigilant amid fears plane passengers could spread the disease. So far 124 people have died and more than 1,000 have been infected in Madagascar, making it one of the island's worst outbreaks in years.

The warning comes after a scare in the Seychelles earlier this month when a plane passenger complained of symptoms. The 34-year-old man was a regular visitor to Madagascar who returned to the country on October 6 before developing symptoms three days later. He was immediately referred to hospital where he was isolated and treated, the WHO said. It was later found he did not have the disease.

Of particular concern is the fact that two thirds of cases are the pneumonic variant of the disease, which is spread through the air and can kill within 72 hours of contracting it. It is more deadly then the bubonic variation of the disease which killed a third of Europe's population in the 1300s. Madagascar sees regular outbreaks of the disease, but this one has caused alarm due to how quickly it has spread and a high number of fatalities. A spokesman for the World Health Organisation said: 'The risk of regional spread is moderate due to the occurrence of frequent travel by air and sea to neighbouring Indian Ocean islands and other southern and east African countries.

'Nine countries and overseas territories have been identified as priority countries in the African region for plague preparedness and readiness by virtue of having trade and travel links to Madagascar. 'These countries and overseas territories include Comoros, Ethiopia, Kenya, Mauritius, Mozambique, La Réunion (France), Seychelles, South Africa, and Tanzania.' WHO has delivered 1.2 million doses of antibiotics to fight the disease while the Red Cross has been training hundreds of volunteers on the island to publicise preventative measures.

The disease is typically curable if antibiotics are administered quickly.

A Foreign Office spokesman said: 'There is currently an outbreak of pneumonic and bubonic plague in Madagascar.' Outbreaks of plague tend to be seasonal and occur mainly during the rainy season, with around 500 cases reported annually. Whilst outbreaks are not uncommon in rural areas, the latest outbreak has seen an increase in reported cases in urban areas, including Antananarivo.'

Madagascar, off the coast of Africa, is a popular destination for British and European travellers.

Madagascar: Plague Outbreak Situation Report, 30 October 2017

• The number of new notified cases have begun to decline following six weeks of intensive outbreak response by the Madagascar Government and partners to the dual epidemics of pneumonic and bubonic plague. While the number of patients decrease, 978 people have been cured, 122 are currently on treatment, and 113 deaths have been reported.

• Between 1 August and 27 October, a total of 1,554 cases have been notified, out of which 985 are pneumonic plague, 230 bubonic plague and 339 unknown. Out of these total reported cases, 332 cases are confirmed, 495 cases are probable and 727 cases suspected. It is noteworthy that only 27 per cent of pneumonic cases have been confirmed so far, while 34 per cent remaining probable and 35 per cent suspect. Considering the current situation and the fact that the plague season in Madagascar runs through April, continued vigilance of the response is required.

• Treatment and referral capacity, data management, contact tracing and communication and sensitization have been significantly reinforced. The current focus is on rumour management, addressing stigmatization, safe and respectful burial, and clarify diagnosis of very young children who are unable to go through regular testing.

• To facilitate the reopening of schools and the return to school for 415,000 children in affected areas, on November 6 (following the precautionary closure of schools on 2 October), UNICEF has been working with the Ministry of Education on plague detection and referral protocol and related special training for more than 15,000 teachers and administrative staff to ensure that children with symptoms are properly referred to treatment centres without causing stigmatization or panic.

• UNICEF’s support to the response, is focused on improving the health case management in treatment centres, including hygiene and wash provisions; facilitating food provision for patients and families in hospitals and a continuously evolving communication response aimed at sensitizing communities on the dangers of the epidemic; advice on how to prevent and access treatment, as well as address rumours; reduce stigma and facilitate work at community level (tracing, referral, burials).

SITUATION IN NUMBERS

Data as of 27 October

1,554 Total cases notified, of which 985 cases of pneumonic plague, 230 cases of bubonic plague and 339 unknown cases, notably in the urban areas of Tamatave and Antananarivo

978 Recoveries

113 Deaths reported

40 out of 114 districts have been affected with the highest number of cases detected in the capital

Estimated required funding for UNICEF contribution to response

US$ 2.6 million

Situation Overview & Humanitarian Response Madagascar is experiencing two concurrent outbreaks of plague: a flea-transmitted bubonic plague outbreak that has spread beyond the usual rural areas where the plague is endemic, into new rural, as well as urban areas; and a second highly-contagious human to human transmitted pneumonic plague outbreak which has been spreading rapidly predominantly in the three main urban areas of the country. The number of reported cases has been steadily rising although appears to have tapered somewhat in the past 10 days. To date, 1,554 cases have been reported and the number of deaths recently exceeded 100.

The response is now in place following intense work over the past few weeks on (1) developing the necessary technical protocols for this unprecedented situation, with WHO leading the epidemiological surveillance, treatment, contact and tracing part of this work and UNICEF leading protocol development for schools, WASH and C4D (including safe and culturally appropriate burials), and (2) setting up previously non-existent treatment and care services at hospitals including antibiotics provision, triage and isolation capacity set up, proper hygiene and waste disposal, training of staff amongst other activities. Nevertheless, several factors continue to make this dual epidemic outbreak very complex to manage:

• A steadily increasing demand to assist in setting up new treatment centres given the rapid overflow of existing hospitals and the emergence of the outbreak in new areas;

• The lack of capacity of some existing centres to provide adequate isolation and hygiene;

• Complexity of data systems, with an over-estimate of “suspected” cases, irregular or incomplete data coming from the peripheral level and a constantly evolving situation

• Strong pressure on Ministry of Education to re-open schools UNICEF is supporting the national response alongside the Ministry of Health, World Health Organization (WHO), National Office for Disaster Prevention and Control (BNGRC), USAID, Government of France, Institut Pasteur, International Federation of the Red Cross, Medecins du Monde, Action contre la Faim and Médecins Sans Frontières (MSF). Significant surge capacity from these international organisations has arrived from abroad in recent weeks.

The news came the day after the Costa neoRiviera liner set sail, its passengers expecting to be whisked, over two weeks, to Madagascar’s white sand beaches and to the nearby islands of Mauritius, the Seychelles and Reunion.

The captain first cancelled one of three Madagascar stops, and later scrapped the other two, including one at the tourist resort of Nosy Be.

This left the ship with just three stops – on Mauritius, the Seychelles and Reunion – which especially frustrated pa

To compensate for the cancellations, passengers were offered €150 (US$175), Costa Cruises said in a statement.

This sparked further outrage among the holidaymakers and led one passenger to call the ship a “floating prison” and organise a protest.

“Things started heating up; €150 when a major part of the trip is cancelled and a glass of water costs €5?” the passenger, Alain Jan, told Le Parisien.

Jan, 53, runs a restaurant on Reunion, a French island east of Madagascar. The cruise departed from that island October 26, at the height of an unusually deadly outbreak of pneumonic plague occurring throughout Madagascar.

Experts think the outbreak began in late August, when a 31-year-old man from the eastern city of Toamasina took a trip inland to Ankazobe, where the plague lives in rodent and flea populations.

While there, the man came down with malaria-like symptoms. He died in a taxi on the way home, passing through Antananarivo, Madagascar’s capital.

World Health Organisation officials said some of the cases identified were directly or indirectly linked to the man, which is evidence of person-to-person transmission.

The outbreak has since infected about 1,800 people and killed at least 127, though WHO officials said there has been a decline in new cases reported since mid-October.

After the crew’s announcement about the cancelled stops, Jan and a small group of passengers demanded a better response.

When they did not hear back, they staged a protest in a restaurant on the ship.

“There were 60 of us clapping our hands to alert other cruise passengers of this scam,” Jan told Le Parisien.

The protest failed.

So Jan organised a second one, this time in a cinema as the ship was nearing the Seychelles.

As the ship docked, the exasperated captain called the local police, the newspaper reported.

The police chief listened to the passengers’ grievances and the crew’s explanation, then asked the captain whether he wanted to kick anyone off the ship.

Jan said the captain pointed at him.

Costa Cruises said it chose to evict Jan because he “made violent protests … not accepting the reason of the change of the itinerary” and had been “disturbing the cruise of many other guests on board”.

For Jan, being thrown off the vessel was a good thing: he said he and his wife spent two nights at a Seychelles hotel and were then flown home to Reunion at the cruise company’s expense.

But he still felt bad for the passengers left behind, and went to greet them when the ship arrived at Reunion.

Some passengers told him “they were treated like cattle”, and they continued to feel ripped off.

“We were 1,200 on board, of all nationalities,” he told the newspaper. “Chinese passengers paid €10,000 per person for this cruise.”

Passengers he spoke with were, he said, upset with Costa Cruises, believing the company made a decision to avoid Madagascar before the ship set sail.

But Costa Cruises insisted every effort was made to stick to the original itinerary.

Mauritius authorities, the company said, were concerned about the ship stopping in Madagascar then sailing to Mauritius with passengers who might have caught the plague.

“Should there be a suspected case on board, whilst also considering that passengers had already embarked, the company was forced to refocus its route,” Costa Cruises said in a statement.

The company said passengers who booked excursions in Madagascar were reimbursed and those who embarked on a Costa neoRivera cruise Thursday were told of the modified itinerary ahead of time.

This article appeared in the South China Morning Post print edition as: Protest on cruise ship after it skips stops over plague fears

PARENTS rushed to schools in the Madagascan capital on Friday to collect their children after rumours emerged that students were being forced into having anti-plague vaccinations.

Madagascar plague: Government battle to stop disease spreading

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Amid growing concerns about the epidemic which is gripping the country and has already claimed more than 140 lives, parents were left outraged after rumours emerged that their children were being given vaccinations without their consent.

According to The Madagascar Express, they rushed to schools across the capital to collect their children after word spread that health officials had arrived with police officers in order to administer the vaccinations.

While plague is very treatable nowadays, health officials claim there is no efficient vaccine against the plague and the World Health Organisation (WHO) advises against administering vaccinations.

The plague factsheet on the WHO website reads: “WHO does not recommend vaccination, expect for high-risk groups (such as laboratory personnel who are constantly exposed to the risk of contamination, and health care workers).”

GETTY•EXPRESS

A health official implements a desinsectisation as the plague outbreak sweeps through Madagascar

According to the Madagascar Express, stones were pelted at teachers and furniture was strewn everywhere as furious parents rushed to collect their children, concerned about the validity of these vaccinations.

One parent allegedly exclaimed: "Are you trying to kill my child or what?”

The director of the CEG Antanimbarinandriana school, Lantoarisoa Ravololomanana, told the parents: “I want to reassure parents that I will not be plotting with so-called plague vaccinators, to endanger the lives of my children. I, too, have two children here.

The Ministry of Public Health has also stated that there is no vaccination against the plague and that people who present themselves as vaccinators are impostors.

GETTY

Schools are a priority for desinsectisation

Local media is reporting a sharp drop in school attendance as Madagascar tackles its “worst outbreak in 50 years”.

Almost 2,000 cases have been reported since the Madagascan outbreak began in early August, with 143 deaths confirmed.

Of the 1,947 cases, 1,437 were classified as pneumonic plague, 295 were bubonic plague, one was septicemic, and 211 have not yet been classified.

Officials say the number of reported pneumonic cases in Madagascar is slowly declining - although more cases of plague are expected as the country enters peak epidemic season, which is due to last until April.

However, this year’s Madagascar outbreak has been particularly rife and spread far quicker than normal.

Workers cleaning and disinfecting the tents where patients sleep at the health center Plague Triage and Treatment Center, in Toamasina

Dr Tim Jagatic, a doctor with Medicins Sans Frontieres (Doctors Without Borders), told Express.co.uk about the cause of this year’s shocking outbreak.

He said: “From November until April, there tends to be an outbreak of an average of 400 cases of bubonic plague per year.

“But what happened this year is it looks like there was a case which happened a little bit earlier, in the month of August.

“If a bubonic case goes untreated, it has the ability to transform into the pneumonic form.

“It seems as though somebody who had the bubonic form didn’t get treatment, allowing the plague to transform into the pneumonic form.

EXPRESS

Ten nearby countries are now on alert as the plague threatens to cross international borders

“He entered the capital city and then fell sick on a bus that was travelling to Toamasina, and a medical student tried to help him.

“The medical student came into close contact with him and because it was the pneumonic form of the disease, happening earlier than its expected to in a part of the country where it typically doesn’t occur, it went unnoticed for a particular amount of time which allowed the disease to proliferate.”

Dr Jagatic added: “A very important part of epidemiology is trying to find who or what was ‘patient zero’, so that we’ll be able to track exactly how it spread, what dangers it poses, who was in contact with that person.

“Once we find that out, it really helps us to cut the chain of transmission and find out what areas of a country we have to focus our resources on.”

Comparisons have been made between the Madagascar outbreak this year and the 14th century Black Death, one of the worst plague outbreaks in human history which is widely believed to have caused the world population to shrink from an estimated 450 million down to 350–375 million in the 14th century.

GETTY

Rat traps pictured outside a primary school in Antananarivo

Dr Jagatic revealed why the two epidemics are being compared.

He said: “There’s a historical stigmatisation – people still use the term ‘Black Death’ which is a term which is associated with the outbreak in the thirteenth century in Europe when 50 million people died.

“According to the records we’ve seen, it seems as though that name was associated with the disease because a lot of people, in this pre-antibiotic era, were falling into the septic form of the disease.

“That septic form, as we now know, caused a loss of circulation in the fingertips and when you have a loss of circulation in the fingers they turn black.

“This disease bore a strong association with sepsis, so every time somebody developed black fingers people expected them to die within the next day or so.”

Still the total neglect of good healthcare-it could mean rich people paying tax-is a very major risk for the global healthsituation. An elite spents zillions on weapons and insane oil-wars but is to stupid and ignorent to care about climate change https://www.thethirdpole.net/2017/11/09/climate-summit-deadlocked-over-immediate-action/ or global healthrisks. They get away with it since the mass media is in their hands. "Sensation sells"-solutions don't.

Que sera, sera, Whatever will be, will be, The future is not ours to see, Que sera, sera !

Still the total neglect of good healthcare-it could mean rich people paying tax-is a very major risk for the global healthsituation. An elite spents zillions on weapons and insane oil-wars but is to stupid and ignorent to care about climate change https://www.thethirdpole.net/2017/11/09/climate-summit-deadlocked-over-immediate-action/ or global healthrisks. They get away with it since the mass media is in their hands. "Sensation sells"-solutions don't.

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